Correcting the Wrong Idea

Pilots sometimes get the wrong idea when it comes to medication use. One of the most frequent questions we get at the Office of Aerospace Medicine is; Why don’t you have a list of approved and disqualifying medications? There are actually a few reasons why such a list is problematic at best. From our perspective, first and foremost, is that an individual’s underlying medical condition is our primary focus, with the medication coming second. That means that we care far more about what you’re treating than how you’re treating it.

This point leads to our second issue: medications can be used for different purposes.

Let’s look at a seemingly simple example, aspirin. Should aspirin be disqualifying? For most people, probably not. But it depends on what you’re treating with that aspirin. For a mild headache, no problem. But aspirin used for heart issues is perhaps disqualifying. That’s why a categorical list of approved and disqualifying medications is not a great idea.

Some medications can be defined as disqualifying regardless of what they are used to treat. The most common offender on this list is diphenhydramine (Benadryl). No matter why you are taking Benadryl, you should not be flying while you’re using it. And you should refrain from flying for at least 60 hours after your last dose, as studies show that next day impairment levels from diphenhydramine are similar to having alcohol in your system.

Need a third reason? With the number of medications introduced every year, any list would be partial at best.

How Do I Know?
There are a few resources we can recommend for airmen regarding the acceptability of certain medications for use before or during a flight. Our primary resource for aviation users is the Don’t Issue/Don’t Fly (DI/DF) list from our Aviation Medical Examiner’s (AME) Guide. The AME Guide is written for physicians, but it is publicly accessible.

The DI/DF list actually includes two lists of medications. The first, D’t, is a list of medications that tell an AME not to issue a medical certificate. If you are taking any of the medications listed here, you should not be flying. The second section, D’t, is a list of medications that airmen should avoid taking while flying. You can find the DI/DF list at: http:// go.usa.gov/cupVh.

Beyond the DI/DF list, you should always check the label of any medication, prescription or over the counter (OTC) drug, for potential side effects. If you see a warning like “may cause drowsiness,” or “be careful when driving a motor vehicle or operating machinery,” take heed. Even if it says “until you know how the medication affects you,” you should probably consider the medication disqualifying.

It’s also important to consider what might happen if the medication you’re taking wears off during your flight. For example, if you are dealing with congestion due to allergies, you could have serious issues if your decongestant stops working mid-flight.

What Else Can I Use?
The AME guide is your best resource, but since it’s written for physicians, it may not be as friendly to laymen as we would like. To give pilots better information about how medication affects performance, we are working under the auspices of the GA Joint Steering Committee (GAJSC) to provide a pilot-friendly training resource. While it will be based on the DI/ DF list, this document will be written in plain language, and it will include information on how pilots should be “self-certifying” before flight. It’s not a complete product yet, but we hope it will be available later this year or early next year. I’m very proud of the work we’ve done to make this resource possible, and I think you will find it helpful in clearing up the confusion about medication and flying.

James Fraser received a B.A., M.D., and M.P.H. from the University of Oklahoma. He completed a thirty year Navy career and retired as a Captain (O6) in January 2004. He is certified in the specialties of Preventive Medicine (Aerospace Medicine) and Family Practice. He is a Fellow of the Aerospace Medical Association and the American Academy of Family Practice.